<%@ page language="java" contentType="text/html; charset=UTF-8"
	pageEncoding="UTF-8"%>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<link rel="stylesheet" type="text/css" href="style/default.css">
<title>Result</title>
</head>
<body>
	<div id="main-wrapper">
		<div id="wrapper">
			<jsp:include page="menu.jsp"></jsp:include>
			<div id="content-block">
				<div id="content-wrapper">
					<h1>New Patient</h1>
					<div class="horizontal-line"></div>

					<form action="new" method="post">
						<fieldset>
							<legend>Personal informations</legend>
							<table id="new-patient-table">
								<tr>
									<td>
										<label for="firstName">
											First Name
										</label>
									</td>
									<td>
										<input name="firstName"
											id="firstName" type="text"
											value="<c:if test="${empty form.error['firstName']}">${patient.firstName}</c:if>"></td>
									<c:if
										test="${!empty form.error['firstName']}">
										<td>
											<span
												class="error formerror">
												${form.error['firstName']}
											</span>
										</td>
									</c:if>
								</tr>
								<tr>
									<td>
										<label for="lastName">
											Last Name
										</label>
									</td>
									<td>
										<input name="lastName"
											id="lastName" type="text"
											value="<c:if test="${empty form.error['lastName']}">${patient.lastName}</c:if>"></td>
									<c:if
										test="${!empty form.error['lastName']}">
										<td>
											<span
												class="error formerror">
												${form.error['lastName']}
											</span>
										</td>
									</c:if>
								</tr>
								<tr>
									<td>
										<label for="mail">Mail</label>
									</td>
									<td>
										<input name="mail" id="mail"
											type="email"
											value="<c:if test="${empty form.error['mail']}">${patient.mail}</c:if>"></td>
									<c:if
										test="${!empty form.error['mail']}">
										<td>
											<span
												class="error formerror">
												${form.error['mail']}
											</span>
										</td>
									</c:if>
								</tr>
								<tr>
									<td>
										<label for="phoneNumber">
											Phone Number
										</label>
									</td>
									<td>
										<input name="phoneNumber"
											id="phoneNumber" type="tel"
											value="<c:if test="${empty form.error['phoneNumber']}">${patient.phoneNumber}</c:if>"></td>
									<c:if
										test="${!empty form.error['phoneNumber']}">
										<td>
											<span
												class="error formerror">
												${form.error['phoneNumber']}
											</span>
										</td>
									</c:if>
								</tr>
								<tr>
									<td></td>
									<td>
										<button class="send-button"
											type="submit">
											Send
										</button>
									</td>
								</tr>
							</table>
						</fieldset>
					</form>
				</div>
			</div>
		</div>
		<jsp:include page="footer.jsp"></jsp:include>
	</div>
</body>
</html>
